THIOCYANATE GOITER WITH MYXEDEMA: REPORT OF TWO CASES*

Abstract

WITH the use of the thiocyanates as therapeutic agents in the treatment of hypertension, thiocyanate goiter has been well established as an entity. The existence of clinical myxedema in association with thiocyanate goiter has been reported. Wald and associates (1) were among the first to report on the formation of a goiter and a decreased metabolic rate in patients receiving thiocyanates for hypertension. Foulger and Rose (2) reported one case in which a goiter and clinical signs of myxedema developed during the course of treatment with thiocyanate. In a case reported by Kobacher (3) myxedema developed, with classical physical findings and a basal metabolic rate of minus 30 per cent. Rawson and coworkers (4) reported two cases, both with goiters and both having levels of protein-bound blood iodine characteristic of myxedema. A biopsy specimen from one patient was reported as revealing an extremely hyperplastic thyroid with marked papillary overgrowth. Potter (5), reporting on the pathology of two goiters (undoubtedly of thiocyanate origin) surgically removed, found brilliantly-staining colloid and no papillary infoldings into the acini. Preoperatively, one goiter was suspected of being carcinomatous and the other of being an acute swelling due to hemorrhage into an adenoma. Motley's (6) patient, to whom thiocyanate had been given for less than a year, had a goiter and a “general appearance quite suggestive of myxedema.” Fahlund (7) reported a painful enlargement of the thyroid gland as a manifestation of thiocyanate sensitivity.